Financial and Health Burdens of Chronic Disease Grow Between 2003 and 2007

More working-age Americans with chronic conditions go without care as medical-bill problems rise.

Almost three in 10 working-age Americans with diabetes, asthma, depression or other chronic conditions lived in families with problems paying medical bills in 2007—a significant increase from two in 10 in 2003, according to a national study released today by the Center for Studying Health System Change (HSC) and funded by the Robert Wood Johnson Foundation.

In 2007, 28 percent of working-age adults (18-64) with chronic conditions—more than 20 million people—reported that their families had trouble paying medical bills in the past year—up from 21 percent in 2003, according to findings from HSC’s 2007 Health Tracking Household Survey, a nationally representative survey containing information on 10,000 working-age adults. The survey had a 43 percent response rate.

And, working-age adults with chronic conditions and medical bill problems were much more likely to forgo or delay needed care because of cost concerns—25 percent, or 5.1 million people, went without needed care; 50 percent, or 10 million people, delayed care; and 56 percent, or 11.3 million people, did not fill a drug prescription in 2007, the study found.

The study also found that the overall prevalence of chronic conditions increased between 2003 and 2007. In 2007, 39 percent of the working-age population, or 72 million people, had at least one chronic health condition, such as diabetes, asthma or depression—a significant increase from 35 percent in 2003 and 34 percent in 2001. The rise in chronic conditions, especially for diabetes, hypertension and heart disease, tracked rising U.S. obesity rates. Between 2003 and 2007, the proportion of working-age Americans classified as obese—those with a body mass index of 30 or higher—grew from 25 percent to 29 percent, the study found.

“The rising prevalence and increasing financial burden of chronic conditions mean more working-age Americans than ever are forgoing or delaying medical care because of concerns that they cannot afford treatment,” said Ha. T. Tu, M.P.A., an HSC senior health researcher and coauthor of the study with HSC Research Assistant Genna R. Cohen. HSC is a nonpartisan health policy research organization funded in part by the Robert Wood Johnson Foundation, which funded the survey and the study.

“This report highlights the double whammy of increased disease and rising costs that are hitting millions of Americans,” said Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO of the Robert Wood Johnson Foundation. “With families feeling the squeeze like never before, and 46 million Americans already living without any health insurance, it’s more important than ever to find ways to make health care affordable and ensure that all Americans have access to quality, affordable coverage.”

The study’s findings are detailed in a new HSC Tracking Report—Financial and Health Burdens of Chronic Conditions Grow—available online at www.hschange.org. Other key findings include:

Uninsured, working-age people with chronic conditions were especially vulnerable to medical bill problems: 62 percent, or 5.7 million people, were in families with such problems—a sharp increase from 45 percent in 2003. Likewise, 20 percent of privately insured people with chronic conditions, or 9.4 million people, lived in families with medical bill problems—an increase from 16 percent in 2003.

Among uninsured, working-age people with chronic conditions and medical bill problems, 38 percent went without needed care, 65 percent delayed care and 73 percent did not fill a prescription because of cost concerns. Rates of access problems for the privately insured with medical bill problems, while lower than for the uninsured, were still considerable: 17 percent went without needed care, 43 percent delayed care and 45 percent did not fill a prescription because of cost concerns.

While rates of access problems remained stable—at high levels—for the uninsured with medical debt between 2003 and 2007, unmet need and delayed care problems for the privately insured with medical debt increased significantly—a finding that is consistent with trends of increased patient cost sharing in commercial insurance during this period.

Among privately insured, working-age adults with chronic conditions and low incomes—less than 200 percent of poverty, or $41,300 for a family of four in 2007—37 percent reported family medical bill problems, underscoring the limitations of private insurance alone in protecting people from the high costs of treating chronic conditions.

The proportion of working-age people with chronic conditions with private insurance declined steadily this decade. In 2007, 65 percent were privately insured—down from 68 percent in 2003 and 71 percent in 2001. About one-fifth of working-age people with chronic conditions had public insurance, primarily Medicaid and Medicare, in 2007, an increase from 17 percent in 2003. The increase in public coverage helped to compensate for much of the private coverage decline, resulting in relatively stable levels of uninsurance (13% in 2007) among working-age people with chronic condition.

The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation’s changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded in part by the Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc.